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Ann Thorac Surg 2003;75:796-801
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Older patients fare better with the Ross operation

^a Sana Herzchirurgische Klinik Stuttgart, Stuttgart, Germany

Accepted for publication September 16, 2002.

^* Address reprint requests to Dr Böhm, Sana Herzchirurgische Klinik Stuttgart, Herdweg 2, D-70174 Stuttgart, Germany.
e-mail: joboehm{at}z.zgs.de

BACKGROUND: The Ross operation has an established position in young patients. We address the question of whether any age group profits most from the Ross operation, and we compare the results in various ages.

METHODS: From February 1995 to August 2001 we performed 250 Ross operations. Group 1 consisted of 46 patients, ages 2 to 25 years (median age, 15 years). Group 2 consisted of 123 patients, ages 26 to 49 years (median age, 39 years). Group 3 consisted of 81 patients, ages 50 to 67 years (median age, 55 years). Echocardiography was performed perioperatively, at 2 to 6 months, and then yearly.

RESULTS: Mean follow-up for the three groups was 32, 31, and 28 months, respectively (p = 0.36). One patient from group 2 died after 25 months caused by suppurative pneumonia and 3 patients from group 3 died (1 from suspected acute thoracic aorta dissection at 40 months, 1 from ventricular fibrillation after 25 months, and 1 from an undiagnosed sudden death at 5 months). Autograft replacement was necessary for 3 patients from group 2 and 1 from group 3. Autograft repair was necessary for 1 patient from group 2, and pulmonary homograft reoperation was necessary for 1 patient from group 1. All other autografts currently have physiologic gradients and clinically insignificant regurgitation. Median peak gradient across the right ventricular outflow tract was 23.6 ± 18 mm Hg for group 1, 14.6 ± 8 mm Hg for group 2, and 11.5 ± 7 mm Hg, which was significantly lower for group 3 patients (p < 0.001). Eleven patients are under close follow-up for right ventricular outflow tract gradients 40 mm Hg; eight of these patients are from group 1, 3 are from group 2, and there are none from group 3.

CONCLUSIONS: Although the Ross operation provides excellent results in all age groups, the problem of right ventricular outflow tract stenosis has not been seen in patients older than 50 years, which implies that it offers superior results for aortic valve disease in middle aged and older patients.

This article has been cited by other articles:

				J. O. Bohm, W. Hemmer, J.-G. Rein, A. Horke, D. Roser, G. Blumenstock, and C. A. Botha A single-institution experience with the ross operation over 11 years. Ann. Thorac. Surg., February 1, 2009; 87(2): 514 - 520. [Abstract] [Full Text] [PDF]

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